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Quantification of cauda equina nerve root dispersion through radiomics features in weight-bearing MRI in normal subjects and spinal canal stenosis patients

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Abstract

Objective

To quantify the distribution of cauda equina nerve roots in supine and upright positions using manual measurements and radiomics features both in normal subjects and in lumbar spinal canal stenosis (LSCS) patients.

Methods

We retrospectively recruited patients who underwent weight-bearing MRI in supine and upright positions for back pain. 3D T2-weighted isotropic acquisition (3D-HYCE) sequences were used to develop a 3D convolutional neural network for identification and segmentation of lumbar vertebrae. Para-axial reformatted images perpendicular to the spinal canal and parallel to each vertebral endplate were automatically extracted. From each level, we computed the maximum antero-posterior (AP) and latero-lateral (LL) dispersion of nerve roots; further, radiomics features were extracted to quantify standardized metrics of nerve root distribution.

Results

We included 16 patients with LSCS and 20 normal subjects. In normal subjects, nerve root AP dispersion significantly increased from supine to upright position (p < 0.001, L2–L5 levels), and radiomics features showed an increase in non-uniformity. In LSCS subjects, in the upright position AP dispersion of nerve roots and entropy-related features increased caudally to the stenosis level (p < 0.001) and decreased cranially (p < 0.001). Moreover, entropy-related radiomics features negatively correlated with pre-operative Pain Numerical Rating Scale. Comparison between normal subjects and LSCS patients showed a difference in AP dispersion and increase of variance cranially to the stenosis level (p < 0.001) in the upright position.

Conclusions

Nerve root distribution inside the dural sac changed between supine and upright positions, and radiomics features were able to quantify the differences between normal and LSCS subjects.

Clinical relevance statement

The distribution of cauda equina nerve roots and the redundant nerve root sign significantly varies between supine and upright positions in normal subjects and spinal canal stenosis patients, respectively. Radiomics features quantify nerve root dispersion and correlates with pain severity.

Key Points

• Weight-bearing MRI depicts spatial distribution of the cauda equina in both supine and upright positions in normal subjects and spinal stenosis patients.

• Radiomics features can quantify the effects of spinal stenosis on the dispersion of the cauda equina in the dural sac.

• In the orthostatic position, dispersion of nerve roots is different in lumbar spinal stenosis patients compared to that in normal subjects; entropy-related features negatively correlated with pre-operative Pain Numerical Rating Scale.

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Abbreviations

3D-HYCE:

3D hybrid contrast-enhanced

AP:

Antero-posterior

CNN:

Convolutional neuronal network

CSF:

Cerebrospinal fluid

GLCM:

Gray-level cooccurrence matrix

GLDM:

Gray-level dependence matrix

GLRLM:

Gray-level run length matrix

GLSZM:

Gray-level size zone matrix

ICC:

Intraclass correlation coefficient

LL:

Latero-lateral

LSCS:

Lumbar spinal canal stenosis

MPR:

Multi-planar reformatted

NGTDM:

Neighboring gray tone difference matrix

PNRS:

Pain Numerical Rating Scale

RNR:

Redundant nerve roots

wbMRI:

Weight-bearing magnetic resonance imaging

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Acknowledgements

We acknowledge ESAOTE s.p.a for the technical support. We also acknowledge Luca Carbone and Elisa Fabbri for the assistance during the MRI acquisitions.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy

    Riccardo Levi, Massimiliano Battaglia, Federico Garoli, Luca Alessandro Cappellini, Mario De Robertis, Leonardo Anselmi, Giovanni Savini, Marco Riva & Letterio S. Politi

  2. Department of Neuroradiology, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy

    Riccardo Levi, Massimiliano Battaglia, Federico Garoli, Luca Alessandro Cappellini, Giovanni Savini, Marco Grimaldi & Letterio S. Politi

  3. Department of Neurosurgery, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy

    Mario De Robertis, Leonardo Anselmi, Marco Riva & Maurizio Fornari

  4. Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy

    Letterio S. Politi

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  1. Riccardo Levi
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  2. Massimiliano Battaglia
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  4. Luca Alessandro Cappellini
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Corresponding author

Correspondence to Letterio S. Politi.

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Guarantor

The scientific guarantor of this publication is prof. Letterio S. Politi.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: R. Levi received funding for Ph.D. fellowship by ESAOTE s.p.a. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

R. Levi is a member of the European Radiology Editorial Board. He has not taken part in the review or selection process of this article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

The IRB was waived by the institutional Ethics Committee of the IRCCS Humanitas Clinical Research Hospital (Milan, Italy), due to the retrospective nature of the study. All the participants signed a general informed consent for MRI and for providing anonymized information for scientific studies.

Study subjects or cohorts overlap

Not applicable.

Methodology

• Retrospective

• Cross-sectional study

• Performed at one institution

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Levi, R., Battaglia, M., Garoli, F. et al. Quantification of cauda equina nerve root dispersion through radiomics features in weight-bearing MRI in normal subjects and spinal canal stenosis patients. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10467-9

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  • DOI: https://doi.org/10.1007/s00330-023-10467-9

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